Monitored
anesthesia care (MAC) is a safe, effective, and appropriate form of
anesthesia for many
minor surgical procedures. The proliferation of outpatient procedures has heightened interest in MAC sedation agents. Among the most commonly used MAC sedation agents today are
benzodiazepines, including
midazolam, and
propofol. Recently approved in the United States is
fospropofol, a
prodrug of
propofol which hydrolyzes in the body by
alkaline phosphatase to liberate
propofol.
Propofol liberated from
fospropofol has unique pharmacological properties, but recently retracted pharmacokinetic (PK) and pharmacodynamic (PD) evaluations make it difficult to formulate clear conclusions with respect to
fospropofol's PK/PD properties. In safety and efficacy clinical studies,
fospropofol demonstrated dose-dependent sedation with good rates of success at doses of 6.5 mg/kg along with good levels of patient and physician acceptance.
Fospropofol has been associated with less
pain at injection site than
propofol. The most commonly reported side effects with
fospropofol are
paresthesia and
pruritus.
Fospropofol is a promising new sedation agent that appears to be well suited for MAC sedation, but further studies are needed to better understand its PK/PD properties as well its appropriate clinical role in outpatient procedures.